We hope we will never lose a single tooth. Unfortunately, it happens sometimes. We can lose a tooth for many reasons. I won’t delve into them in this article. The purpose here is to help you to decide between a bridge and an implant, in the event that you have to make that choice.
Just so we are clear: No two situations are completely alike. I have neither seen nor evaluated your case and am simply discussing general principles. You should always consult a comp
etent and licensed professional to assess your specific circumstance before making a decision that will affect both your health and finances. Nevertheless, here you are. Either a tooth has been compromised and is lost already, or it is about to be extracted. If the idea of dental implants has crossed your mind, your dentist first has to determine whether you are a good candidate for the implants. The criteria can be broken down into three broad categories:
Do you have any medical issues that may prevent successful placement of an implant?
Do you have sufficient bone?
Will your existing bite allow it?
So let’s get into it:
1. Medical Issues. Health conditions that could prevent an implant being placed may include, but are not limited to:
Diabetes
Recent heart attack or stroke
Immunosuppression
Drug abuse
Active treatment of malignancy
Intravenous bisphosphonate use
You should disclose anything you think could be a matter of concern with your dentist. The success rate with dental implants is very high, but careful case selection is the key to success.
2. Sufficient Bone. Again, this needs to be determined by the implant surgeon. Your bone needs to be high enough and wide enough to accommodate the implant. If it isn’t, you may still qualify for a dental implant, but will likely require an additional procedure called bone grafting. Your dentist or implant specialist will determine your specific needs.
3. Your Bite. What does the bite have to do with anything? There was a tooth there to begin with, right? Both implants – and natural teeth – survive longer when your teeth and jaw are in harmony. If your bite has collapsed – meaning the upper jaw and lower jaws are now too close to each other – there may not be enough room to place an implant without orthodontic (braces), or surgical, intervention.
Starting to sound a bit complicated? Don’t worry, in most cases, the dentist can tell you pretty quickly if he feels implants will work for you. Sometimes, he needs additional screening tools to make the final call but, if he does, he’ll let you know that too.
As the year’s end approaches, I am taking this opportunity (yet again) to share a tip that can help you take full advantage of any dental insurance benefits you may have.
While some patients well understand how their insurance operates, I have learned that others do not. So let’s undertake a quick review:
The way your dental insurance benefits work is that you are provided with a certain dollar amount of benefits each year. If you do not use those benefits you will lose them! (Unused benefits do not carry over to the next year). Many people do not realize this and allow hundreds (sometimes even thousands) of dollars worth of benefits to remain right in the insurance company’s bank account. While treatment should never be dictated by insurance, if you have any treatment that remains to be completed, or you have any dental concerns at all, it would be very useful for you to come in before the end of the year.
Our goal for each of our patients is to help them enjoy the best oral health possible for their circumstances. For you, that probably means that you look good, you feel good, you have strong teeth and gums, and you enjoy the benefits of a healthy, attractive smile over your lifetime.
If you would like to make an appointment, just give us a call and we will find a time that is convenient for you. Just remember that when the clock strikes 12 midnight on December 31st, you will lose unused dental benefits. We will be happy to help you get the full benefits to which you are entitled under your dental benefits policy. If you know you’ll need more than one visit, give yourself enough time to have your work completed with whatever benefits you have remaining, so call today.
Recently, a great deal of attention has been placed on economizing in all different aspects of life. Some people have even considered cutting back in the area of health care by putting off routine maintenance care. While this is a little like playing Russian roulette when it comes to dental health — for reasons I’ll explain shortly — there may be a better way to dodge the financial bullet. And it may be a much simpler one.
After more than twenty years of practice I have seen people consider all sorts of ideas to deal with rising dental costs. Often, people become fixated upon dental insurance as the primary solution to the majority of their dental needs. Because dental insurance generally tends to be pretty expensive relative to what it pays out, especially if you are buying it yourself, patients that rely on it exclusively often end up worse than when they started. Dental insurance typically has waiting periods before it can be used, during which time existing conditions advance, becoming more expensive.
In these cases, you have to wonder – if the premiums are costing you more than what the company pays you back – what’s the point? Obviously, this arrangement is a much better deal for the insurance company than for the patient. Let’s also consider that when I first started practice, dental insurance maximums averaged $1,000 to $2,000 annually. Twenty years later, they average . . . $1,000 to $2,000 annually. If insurance kept up with inflation alone, the annual maximum should easily be over $5,000. Don’t hold your breath for that one though. Patients would be better off just setting aside the amount they pay for premiums. They usually come out better in the end.
Putting off dental care often becomes more costly to patients for several reasons. Firstly, many dental conditions are actually painless in the early stages. Periodontal disease is a prime example. This is a condition in which the bone surrounding the teeth becomes lost, leading to a variety of circumstances including bleeding gums, loose teeth, bad breath and, eventually, tooth loss. It is the number one reason that people loose teeth world-wide. For the most part, it doesn’t hurt. When it does, if it does, it is usually too late. The tooth or teeth have to come out.
Likewise, dental decay usually doesn’t hurt in the early stage. Actually, I’ve lost count of the number of times it didn’t hurt in the advanced stage either – but this is usually the point at which the patient becomes aware of a problem. A piece of the tooth breaks off, or they actually experience pain. The tragedy of this scenario is that when it reaches this stage teeth often end up requiring more expensive root canal therapy or extraction. Dental costs can very quickly escalate as much as ten times from the cost of a simple filling to what it costs to complete a root canal and crown.
So what do you do? Focus upon prevention.
Here is a true story I hope will leave as big impression upon you as it did me at the time:
When I was a dental student, I recall a lecture give by one of my professors in which he made a powerful point on the subject of prevention. The seminar dealt with the subject of prosthetics – more specifically, the fabrication of crowns and bridges. This professor, however, was one of those rare dentists who actually had two recognized specialties. He was a professor of prosthetics, but he was also a periodontist. While this was a crown and bridge lecture, he taught us a very valuable periodontal lesson.
Here’s what he did. The seminar was pretty informal at this point. The professor told us he was going to put up some slides of patients and have us guess their ages – just by looking at their x-rays and then at pictures of their gums. As a student, I remember thinking this was a refreshing little game and most of the class was doing quite well calling out the ages. Looking at the x-rays, we would evaluate bone levels, tooth eruption patterns, tooth wear, number of restorations and similar factors to make our “guess.” Then we would look at the color and texture of the gums and appearance of the smile and offer up our estimate. The professor would then show us the face of the patient and tell us their age. This went on for a while and we all did pretty well.
He then put up the next slides and guesses rang out: “twenty-five,” “thirty,” “twenty-seven,” went the typical guesses. I don’t think I can remember seeing a single filling on those slides, though there could have been. Nothing changed when he showed us a picture of the gums. They looked like a teen-ager’s. Then he put up a picture of the face. The person pictured was obviously in their late seventies, maybe even early eighties.
Dead silence. Then there was a small commotion and most of the class pointed out that the slides got mixed up.
The professor paused, and said “No. This is correct. Let me tell you how I can be sure. This is a picture of my father. Those are actual x-rays and a recent picture of his gums. How is it that he has such excellent oral health?”
He then went on to tell us how when his father was a younger man, he had a visit with his dentist and he complained to him that whenever he ate, he would get food stuck between his teeth. His father wanted to know if there was anything he could do about it, because it was pretty annoying.
The dad’s dentist thought about it for a second and told him: “Well, I’ll tell you what I do when that happens to me. I go over to my wife’s sewing kit and take out a piece of silk thread and just pass it between my teeth.” As a student, I wondered when floss became invented. Evidently, it just wasn’t popular back in those days.
In any case, our professor went on to explain that his father did exactly that after every meal since he was a young man. His gums, teeth and bone levels were almost unchanged. That’s what he had to show for his efforts.
I filed the image in the back of my mind, but I have to be honest – I didn’t exercise the same level of commitment – just yet.
Oh, sure, I brushed, watched what I ate, and took vitamin and mineral supplements. But my flossing was sporadic. That is, until I really started looking at what happened to my patients and how those who flossed performed against those who didn’t. If you asked me today: do I floss regularly? Absolutely. You can’t buy cheaper dental insurance.
Flossing benefits your gums, your breath, your teeth, your lungs, your heart – in short, you.
Do you know that probably up to a third of the cavities I treat happen between the teeth? This is why regular exams are so important. You simply can’t see this area. For that matter, without x-rays, neither can I in most cases. But my point here is simply this: even if you brush after every meal and snack, without flossing this area never gets cleaned. Why would anyone become surprised that an area that never got cleaned could decay over time?
There are all sorts of reasons people don’t like to floss, but the reasons to do it are actually pretty compelling and very cost-effective. Think it over. Maybe floss is the most affordable dental insurance. . . .
Consider this article a public service announcement. I really dislike it when patients lose their teeth unnecessarily. My practice philosophy is that if a person has a dental problem, the goal is to handle that difficulty first, but then empower the patient with the correct knowledge that will keep him out of trouble from there on out. Ideally, my hope is that most future visits to my office will only be for routine maintenance.
Unfortunately, and all too often, I encounter new patients with teeth that are so badly decayed there is little hope of salvage. Possibly just as frequently, I find these patients scheduling a checkup – usually after a long absence from dental care – who are surprised to learn that they have any cavities at all. Sometimes they will think they lost a filling when, in fact, a piece of their enamel has broken away.
Why are they surprised? The common denominator seems to be the idea that cavities are supposed to hurt.
Well, sometimes they do hurt. But most of the time – especially in the early stage – they don’t.
In fact, by the time a tooth does start to hurt you it’s usually pretty bad. More often than not, it is so bad that a dentist is evaluating whether it can be treated with endodontic (root canal) therapy or whether it needs to be extracted. A little understanding of basic dental anatomy is helpful here.
Take a look at the illustration below:
The outer layer of the tooth is comprised of enamel. This is the hardest substance in your body. It breaks up your food and is designed to last you a lifetime.
And now, here is the important part for you to understand: it doesn’t contain any nerves.
It is more than ninety-five percent mineral. Water and organic materials make up the balance. And because it doesn’t have nerves, it doesn’t have feeling. This is actually quite practical since it wouldn’t do to have pain every time you bit into something. On the other hand, it also means that it can be decayed without giving you a warning.
In fact, decay can also travel into the supporting layer – the dentin – and still not cause you pain. It usually has to travel pretty close to the inner layer that contains the blood vessels and nerves – the pulp – before you feel it. Of course, by then, the tooth has generally undergone considerable destruction.
Another factor that makes spotting decay difficult is the way it spreads. I have drawn two black triangles into the enamel above. Notice that the narrow point is on the outside of the enamel. The broader base faces the inside of the tooth. This is how decay usually travels. Sometimes, it will undermine the interior of the tooth while the outer, harder enamel still maintains its form . . . until it eventually crumbles because the underlying supporting dentin has been eaten away by decay.
Many cavities also form at the contact point between two teeth. These are areas that you simply cannot see. Even the dentist needs an x-ray to spot these cavities in most cases.
So what does all this really mean? Spotting decay is not always that easy. As dentists, we use visual examination, but we also rely on probes, x-rays, and even laser detection devices to locate cavities. Even then, it can be difficult to find cavities under existing fillings.
Don’t rely on pain to tell you if you have a cavity in your tooth. If you do, you can be assured that your treatment is likely to be more uncomfortable, expensive, and may even result in the loss of a tooth that could have been treated much more easily earlier in the game.
If you have a loved one, who still has their teeth and hasn’t seen a dentist in a while, have them read this article. You may be saving them from quite a bit of discomfort – not to mention time and money – if they catch potential problems before they are hopeless.
Some of you may be thinking, “No big deal. If it’s that bad, I’ll just pull it.” OK, sometimes that is necessary, but therein lies a lesson for another day.
Not long ago, I heard something from a patient that really surprised me. Now, that in itself is significant, because after practicing dentistry in Philadelphia for over 20 years, I thought I had just about heard it all. This patient, who up until recently had a great record of regular follow-up visits for cleanings and check-ups had been missing in action for about a year and a half. After we caught up with her and found out what was behind her unusual lapse in dental care, I learned that, among other things, she had been listening to a friend who had asked her: “Why do you want to go to the dentist? He’ll just find things that are wrong with you. And it’s so expensive.”
Wow!
Quite apart from the fact that this patient usually left her checkup without a need for any additional treatment, I thought to myself “With friends like that, who needs enemies?”
Well, here’s one to chew on: Let your oral health go and sure it may be expensive. That is, if you choose to get back into shape. Maybe even really expensive.
But, take care of yourself and – unless you have a serious accident – it’s very unlikely.
Statistically, I have found that patients who keep up with their bi-annual visits, have far less treatment that needs to be done. At times, an old filling or two may require replacement, but usually not a lot beyond that. That’s just normal wear and tear.
People who grind or clench their teeth often experience a higher need for dental work due to added stresses on their teeth, but we have solutions for this too.
All-in-all, having regular check-ups keeps the bulk of your hard-earned money in your pocket and not mine. Think about it. It’s just common sense.
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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